Friday, April 30, 2010

You guys have heard me bitch about the miserable sleep-deprived, food-deprived, caffeine-deprived condition called "being on-call" that us docs live through.

I describe things best with words. My esteemed colleague Fizzy, however, draws pictures. And for those of you who, after reading my blog, still don't understand the state of desperate insanity that being on-call causes, I present Fizzy's recent, very accurate, pictorial description.

Cell phones, and our love/hate relationship with them, are a popular blog topic. Rude patients/customers/doctors who conduct routine calls solely to inconvenience those around them are a popular gripe topic. But that aspect of the damn things isn't what I'm bitching about today.

Millions of years have gone into humans figuring out how to survive danger and carry on the species. But modern technology has turned the clock backwards on this.

In the 1980's video cameras become cheap and widely available. Suddenly, instead of frantically running away from tornadoes, every bozo suddenly felt the need to stop and shoot movies of them, hoping to get 5 minutes of fame on the local news. I'm not talking about trained stormchasers here. These were always local yokels in a car, with their terrified kids screaming in the background, who pulled over to get some once-in-a-lifetime shots of an oncoming funnel cloud as it destroys their house. Nice work.

Similar videos popped up with every earthquake. "Hey! The house is shaking! I'm gonna film this for a minute, then check on the kids!"

But the phenomenon has gotten worse with the invention of the cell phone camera.

Besides the obvious dangers of distracted driving, now every disaster is accompanied by people frantically whipping out cell phones. Some take pictures of it. Others feel it's a great time to call friends. "Yeah, the building is on fire. You wouldn't believe it. I should probably leave soon. How was the poker game last night?"

It's obvious to anyone that you can run faster if you swing BOTH arms. So if you're running for your life, it would seem counter-intuitive to swing only one. Right? Now let's look at this screen shot from CNN earlier this year, of people fleeing aftershocks of the Chilean earthquake.

Yup. Both of them are running, and talking into cell phones (not to mention the person who stopped to take their picture).

"Yeah, It's a bad aftershock. I hope it doesn't knock over the cell phone transmitter antenna. If it does, I don't know how I'll be able to call Marta to tell her about the aftershocks."

Imagine you're a prehistoric man in a cave. Suddenly a saber-toothed tiger walks in. Your reaction, sensibly, is going to be either to run like hell or find a club. Somewhere along the line our intelligence allowed us to survive these encounters.

But nowadays people are different (I'd like to thank my reader, Lee, for sending this):

COTTONWOOD, Arizona- A bobcat walked into a roadside bar in Cottonwood.

What happened next was not a joke but "pandemonium," two or three minutes of chivalry, cell phone cameras and people jumping on top of pool tables to get out of the way.When it was over, two people were scratched and bleeding, and the rabid bobcat was killed by police in a parking lot on Main Street.

At about 11:40, three people walked out of the Chaparral, a neighborhood bar with signs for Schlitz, Budweiser and Coors over the entrance. Tuesday is free-pool night.

"I said good night," said bartender Scott Hughes, 41. "Next thing I know, they are running back in, followed by a bobcat.One jumped on the pool table, and two more jumped onto the bar."

The bobcat chased two people around a pool table.That's when people took out their cell-phone cameras to get a picture.

People talk about the degradation of morals and the end of society. Hell, we've survived a lot, and I'm not worried about political hysteria from either side.

Wednesday, April 28, 2010

"Hi, this is Hank Bozo. I just found an old message on my cell phone reminding me to come to my appointment with Dr. Grumpy on March 19. Can someone please call me back and let me know if I showed up for it, and if I did, what we decided to do. If I didn't show up for it, I want to make another appointment. Thank you."

Tuesday, April 27, 2010

And, since patients have to inject it into themselves, I think it's great that you put together a demo kit to teach them how to do it.

I can understand that your demo kits don't have the real drug in them. I mean, this is an expensive monoclonal antibody with a short shelf life. You don't want it sitting in a doctor's cabinet collecting dust. So it makes sense to have a non-drug demo for teaching purposes.

There are a lot ways this could have been labeled. Like "does not contain real drug" or "do not inject the demo product" or "for demonstration only, do not inject."

But, in all honesty, putting "not for use in humans" on the demo drug's packaging IS NOT going to inspire patient confidence in your product.

It's actually a battery-powered shower-cleaning device that sprays foaming suds around your shower after you're done. Of course, I know that NOW. I didn't know it yesterday.

While I was on call this weekend, Mrs. Grumpy installed one in our shower, and didn't mention it to me.

So yesterday morning, I was showering away in the dark (I get up early, and shower in the dark so the lights don't wake up the kids). In the dim glow of the night-lite I noticed this gadget hanging there, looking suspiciously like a soap dispenser. So, to lather up, I pressed the big blue button on the front, and put my hand under it.

Nothing came out. Instead the thing began beeping REALLY LOUD.

BEEP!

Holy shit! What the fuck kind of a soap dispenser is this?

BEEP!

Crap! Why is it beeping? It's going to wake up everybody! How the hell do I make it stop?

BEEP!

Fuck! There has to be a button or switch or something to turn it off! I'll press the blue button again!

BEEP!

That didn't do anything. Shit, I can't see if there's another button to make it stop!

I leaned forward, feeling it all over to try and find a switch.

BEEP!

After the 5th BEEP! the little blue thing on the bottom suddenly spun around, spraying shower-cleaning foamy stuff in a circle around it, covering the shower, the tiles, and my eyes, which were about 2 inches in front of it as I frantically tried to find a way to make it stop beeping.

It burned like hell. I screamed and fell backwards, and some shampoo bottles fell on me with a loud clatter. Snowball started barking. In the panic I tried to get to a sink to wash my eyes out, before I realized that I was already in a shower with water pouring down.

As I rinsed my eyes out the lights went on, and I became aware that I'd woken up the whole house. Wife, kids, dogs, and all.

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Us doctors will see you from 5-30 minutes a day (30 is A LOT), depending on how sick you are. And the rest is the nurses.

They come in all shapes, colors, and sexes. Yes, there are a few idiots out there, that I take shots at in this blog. And there are idiot doctors, too. Idiots are in all fields, but the majority of nurses are damn good.

They're the ones making sure you get your pills, checking that your vital signs aren't dropping (and doing what they can to save your ass initially if they are, of which calling a doctor is only one part). They make sure you don't fall down and break something. If you start barfing, us doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They'll bring you a warm blanket. And clean disgusting things off you. Even if you're drunk. Or delerious. Or mean. And through all of this they try be friendly and positive. Even though you aren't their only sick patient.

I respect nurses A LOT. I learned early on that they're key to being a good doctor. You piss off the nursing staff, and you'll have a miserable career at that hospital. Respect and treat them well, and you'll never regret it. They're as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they'll teach you. A good neuro nurse is often a better inpatient neurologist than some doctors I've met.

I remember a guy named Steve, who was an intern with me a long time ago. He had his head up his ass about being a doctor, and saw nurses as lesser scum. We were only a few months out of med school, and as we were writing chart notes one morning a nurse came over and asked if he'd go listen to his patient's heart. With icy contempt, and not even looking up from the chart, he said "I don't have to listen to his heart, because I looked at his EKG." They ain't the same thing, dude. If he'd listened he might have noticed that the patient had developed a loud murmer in the last 24 hours. When the attending caught it a few hours later, Steve got his ass chewed out. If he'd taken the nurse's advice, and listened, he wouldn't have gotten reprimanded by the residency board.

I talk about my Bible a great deal in this blog. Here's a quote from it: "Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom."

Those doctors are also depriving themselves of friends. On a shitty day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn't make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient's family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said "Oh, this kind is my favorite, it has cream filling."

And some pig in one of the rooms yelled "Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!"

You say that to a waitress, and you'd likely get your ass kicked out of the restaurant.

You say that to a co-worker, and you'd be fired and/or sued for harassment.

You say that to a lady in a bar, and you'll likely get a black eye.

And what did the nurse do? In spite of the fact that the guy was obviously a detestable jackass, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire the hell out of that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

While this post isn't about them, there are a lot of other unsung heroes who are part of the hospital team- pharmacists, social workers, nursing assistants, EMT's, respiratory therapists, X-ray techs, lab techs, physical/occupational/speech therapists, housekeeping staff. And many more.

Saturday, April 24, 2010

I'm not personally into hookers and cheap motels. If you are, I don't care. It's just not my thing.

It is important, however, to keep in mind that those rooms are generally NOT used by people who have any need to look in the rooms' closets. After all, they're only renting them for 20-30 minutes.

So as a result, sometimes a homeless alcoholic can (hypothetically speaking of course) live in the closet of one of those rooms, undetected, for weeks.

Like all people, they might get sick. There's always a lot of crud going around.

So, if their timing is off, they might wander out of the closet, and vomit all over a hypothetical couple using the bed to conduct a business transaction.

Since nothing kills the mood of cheap sex faster than being covered in barf, Mr. John and his girlfriend-for-hire might hypothetically grab their clothes and run out of the room, followed by Mr. Drunk, who passes out in the parking lot.

He eventually might be found and brought to Local Hospital, where he (hypothetically of course) could have an alcoholic seizure, and so a neurologist was consulted (I mean, uh, might be consulted, since this is, a um, hypothetical case).

So, guys: if this is your sort of thing, please check the closet first. Your date won't mind, I swear.

If you find someone living in it, just ask for another room. It may save me a trip to the hospital.

Friday, April 23, 2010

Generally, I find my practice works best when I get paid in dollars. They're convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.

But, in a remarkable effort to win the "Let's See How Stupid I Can Sound" award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going to a barter system with them. Specifically, she suggested paying us in chickens or house painting.

Really.

Sue Lowden is the gem who hatched this idea. In fact, she was given a chance to explain it, on the assumption that she misspoke. But nope. When given the opportunity to clarify her point, she again clearly stated that medical services should be reimbursed by bartering goods, such as chickens, and not by paying money. She specifically indicated it was to pay doctors, and didn't say if it should be applied to other businesses (such as buying your meds at the pharmacy, or groceries at the store). She even said she wasn't going to back down from the idea.

Barter is not a bad thing. In some situations it works. Most civilizations used it before the advent of money. But the majority of human cultures eventually developed cash of some form. Because let's face it: It's hard to carry around enough chickens to buy a car. And they're messy. And, unlike coins, they require feeding.

This idea may work for some docs, but not me. I personally don't want to collect co-pays in chickens. Or goats. Or frying pans. Or anything other than money. This is also a matter of cleanliness: my migraine patients are sensitive to smells. I don't think they want to sit in a lobby filled with the livestock someone else brought to settle their bill.

And I don't have enough space in my yard to handle all those co-pays. Mary and Annie are also not going to be thrilled to be told that instead of money I'm now going to pay them in sheep and legumes. It's a baaaaaaaahhhhhhhhhd idea.

The logistics of making an ER co-pay become especially daunting, paticularly if you're now in a wheelchair but need to use the space in your car for bushels of corn and some turpentine.

And just try giving your kids a handful of chickens to spend at Chuck-E-Cheese's. Have you ever had to clean feathers out of a skee-ball machine? It's trickier than it looks.

We will also need to re-do medical school curriculum, to include care and feeding of livestock, as well as how to run your own slaughterhouse (for us non-surgeons) when turning your co-pays into dinner.

Ms. Lowden, to verify the usefulness of your idea, why don't you try a simple experiment- go into any large casino in Las Vegas. With a chicken. And try to bet it on any game. Or stuff it in a slot machine. And then see what casino security thinks about being paid in something other than money. I suspect they'll be as fond of the idea as I am.

The following note is from a doc who specializes in weight loss, trying to figure out why the patient is still heavy. I personally would have worded this differently, as there are some details about my patients' lives that I just don't want to know.

Thursday, April 22, 2010

The following column is not mine. It was written by The Mother, (who's a mother AND a doctor) and due to my own fascination with, uh, advancing scientific research, I'm reprinting it here.I should point out that on any given day there are an average of 1,370 earthquakes on planet Earth, (and probably a few on Io, too). So you can blame them on whatever you want, and they'll still happen.

A critical thinking experiment in real time

I’ve been talking a lot lately about teaching kids critical thinking. I’ve been pretty hard on the schools, for stressing memorization and regurgitation, and ignoring the process

But on Monday, April 26, we all have a chance to strike a blow for critical thinking on a global scale.

Let me explain.

Over the past six months or so, a variety of garden-variety idiots have variously attributed tectonic plate phenomena to cosmic wrath.

Pat Robertson explained on national TV that the Haitian earthquake was caused by retribution for the Haitians’ “pact with the devil” over the bloody slave revolt in 1790 (wow, did that take the deity a seriously long time or what?).

And Iran’s Hojatoleslam Kazem Sedighi announced that “Many women who do not dress modestly … lead young men astray, corrupt their chastity and spread adultery in society, which (consequently) increases earthquakes." (We are women, hear us roar–our boobs have unimaginable power.)

This last inane statement, unlike the first two, is what we science types call a “testable hypothesis.”

And it is going to be tested. Oh, yes. A critical thinking experiment is being planned in real time. The brainchild of Jen McCreight, who blogs at Blag Hag. BOOBQUAKE is designed to test the concept that immodest dress causes tectonic plate disruption.

Women are asked to wear their lowest cut, most immodest blouse on April 26th. If you happen to wear a short skirt, too, I can’t imagine that that would skew the results.

I have a see-through t-shirt that should do nicely.

To drive the lesson home to our kids, though, it’s important to make sure they understand the working hypothesis of the experiment. Then park them in front of CNN for the day, and let them watch, like we did when Katrina was leveling New Orleans.

I don't know if I'll be able to afford the increase, but will do my best. I know you're doing your utmost to try and keep my rates down, as evidenced by the fact that you spent 44 cents per letter to mail this to several thousand offices across the country.

(click to enlarge)

In times like these an increase of this magnitude might be devastating, but Mary and Annie have heroically chipped in to pay for the increase, with some money they found in the cushions of the waiting room chairs.

Monday, April 19, 2010

The Science Marches on Department sent me this remarkably confusing (and, in my opinion, bizarre) abstract from the Journal of the American Psychoanalytical Association. Don't believe me? Here's the original.

The absence of the paternal penis.

“Girls’ experiences of object loss, in conjunction with female anatomical structure, may lend themselves to a particular genital anxiety regarding openness and emptiness. The relational void in giving up the mother as love object may lead to an internal self-representation of a “hole” to be filled, much as the mouth sucks the pacifier in the absence of the nipple. This image may then be extended to the genital representation. In turning to the father, a girl may find that she lacks a relationship with him in the relational space opened up by the loss of the mother; the penis is symbolically withheld from her in the father’s relational distance. This lack of sexual and relational gratification, it is proposed, may be schematized by a female as her body being empty of something. The father’s absence–the absence of the paternal penis–may lead to an absence of the mental representation of the vagina and to an inhibition of the role the vagina then plays for a woman in sexual desire. Vaginal repression may serve to disguise object hunger that might otherwise be experienced as vaginal longing. An abbreviated clinical vignette, revolving around a masturbatory fantasy, is offered in partial illustration of the thesis.”

I was informed by certified mail last week that I've been approved for my state's substance abuse monitoring program, being able to look up ALL my patients' controlled substance scripts from all pharmacies and other doctors.

I activated my incredible new all-seeing powers this morning. And within an hour had fired 3 patients that we were suspicious of.

Mary and Annie are making up wish lists of people for me to check. It's like Christmas, in April.

Mrs. Grumpy wanted to go for a carb-laden meal at La Enchilada Grande last night, so I'm very sluggish this morning. And all I could think of while driving in was this.

Interestingly, it wasn't used as an ad. It was done by students in a college film program, and won an award. I actually first saw it in a movie preview, when I took the kids to see Shrek vs. Rocky LXXIIIV.

So yesterday we had 2 (not 1, but 2!!!) calls from people wanting to know what their MRI's showed.

I usually try to keep up on test results, calling patients or bringing them back as soon as we get them. So it surprised me to get 2 in one day. But sometimes things fall through the cracks. I couldn't find their reports, so I asked Annie to track them down.

Guess what? NEITHER OF THESE BOZOS EVEN SHOWED UP FOR THE FUCKING TEST!!!

I'm not making this up. Annie called the MRI places she'd scheduled them with. Both were no-shows.

So she called the patients back. Both were aware that they hadn't had the tests, but thought they'd call us for results "just in case".

(For the record, both of these patients were being seen for back problems. Not memory loss or head injuries. If that was the issue it wouldn't be so shocking, or even blogworthy).

Look, people, here's a tip. The MRI is a VERY GOOD test. My specialty depends heavily on them.

But no matter how good they are, they CANNOT get images of you while you drive by the facility. Or sit at home reading about how horrible they are on bigdavespageofhowanMRImademydickfalloff.com. Or lying on the couch watching TV and eating Fritos.

She was on the cover of an ad brochure one of my drug reps dropped off. It's for a pill used for excessive daytime sleepiness.

What I think is funny, though, is that the pictures on the left (the "before drug" shots) are supposed to be abnormal.

Lets start at the top:

1. Lady dozing off at work. Who doesn't do that here and there? Hell, I slept through most of my pathology class in medical school. To this day I'm conditioned to automatically nod off when I hear the word "amyloid". And it's not even like she has a can of the sacred waters next to her.

2. Lady finding ironing boring and tiresome. As if anyone froths at the bit and has an adrenaline surge at the thought of finally getting to that mountain of wrinkled clothes.

3. This one is my favorite. The lady has fallen asleep while her boyfriend/husband is watching sports. Mrs. Grumpy is the sports person at out house, but I know plenty of women who consider dozing off in these situations to be perfectly normal. Let's face it- I'm pretty sure he's not watching figure skating.

Personally, if I see anyone who looks like the lady on the right at work or doing housework, I think they need their Lithium dose lowered.

The Goodwin family. From left to right: William, Frederick, Charles, Harold, Lillian, Augusta, Jessie. The baby, Sidney, is not in this picture.

Even through the old black and white, they could be any family you live near. They look like nice people. Clothing styles have changed, but they're the same people we are now.

You can see them getting ready for this family portrait, which likely wasn't cheap. Putting on their nicest clothes, trying to get their hair just right. Harold and Jessie each with a trace of a smile. Maybe they'd shared some sibling silliness just before the picture was snapped, and were told to be knock it off and look at the camera.

We still take family pictures. To freeze those memories of childhood and family that we all hold dear.

Mr. Goodwin, at age 40, was a highly trained electrical engineer. He was having trouble finding steady work in Fulham, England, that would allow him to support his family.

But through his brother in America he heard of a new power plant under construction, in Niagara Falls, New York, that was looking for men with his training. So in hopes of finding a better life, the family sold their modest house, packed up, and booked passage across the Atlantic. They didn't have a lot of money, so had to settle for 3rd class passage.

The food and accommodations in 3rd class, while not great, were certainly adequate. The only potential drawback was that, in the unlikely chance something went wrong, you wouldn't have as easy access to the lifeboats as the wealthier 1st and 2nd class passengers did.

And for that reason, 98 years ago tonight, the entire Goodwin family died on the Titanic.

On a side note, the body of a small boy was found floating in the Atlantic 3 days after the wreck. He was buried in Fairview Cemetary in Halifax, with a monument paid for by the sailors who'd pulled him out of the water. He was listed as an unknown child victim of the Titanic. In 2007 DNA testing confirmed he was indeed the youngest Goodwin, Sidney.

I'm sitting down to dinner with my family. My cell phone rings. It's the ER. A patient has just had a stroke, and is a candidate for the "clotbuster" drug, TPA. The drug MUST be given within 3 hours of symptoms onset. It's a serious emergency.

I leave my plate on the table, yell goodbye to the family as I run out the door. I race down the road, and onto the freeway.

I get to the hospital. I pull into one of the special "doctor emergency" slots by the ER entrance. I wave to Willy, the security guy who's been sitting there watching the lot for the last 40 years (he's rumored to be the last surviving veteran of the Spanish-American War of 1898).

I run in. I meet with the family as the patient is being wheeled to CT. He comes back. I look at the CT and call the radiologist. I examine the patient and go over the checklist for TPA, and explain the risks and benefits to them.

The family and patient are willing to throw the dice. The volatile drug is given as we watch. I re-examine him every few minutes. We get a bed in the ICU, and the patient is wheeled off. I write further orders and make phone calls to an internist and cardiologist.

Only time will tell.

And I walk out to my car, hoping to get home before the kids are asleep, and to have some dinner.

Sunday, April 11, 2010

While I was on call today, Mrs. Grumpy took the kids to Humungous House O'Toys. Because the kids had some gift cards they were dying to use.

So what did all 3 of them buy? Out of all the cool stuff at Humungous Toys? Video games? Some awesome electronic flame-throwing robot dinosaur? A really cool Lego set?

Nope. They each wanted a "Perfect Petzzz".

For those of you unfamiliar with this remarkable use of technology, it looks like a sleeping dog or cat. And all it does is "breathe". The abdomen repeatedly deflects in and out by a 1/4 inch to give this amazing impression.

Let's watch!

Impressive, huh? Exciting beyond words, right? What else does it do, you ask?

THAT'S ALL.

It's fixed in that position. The limbs don't move. The eye's don't open. And, under the fake fur, it's hard as a rock. Seriously. You can hammer nails with it.

It looks like it's breathing, but when you pick it up your first impression is that it's in rigor mortis.

Visually, it's cute for all of 5 seconds. And when you find out that the pseudo-breathing is all it does (until the battery runs out) you're absolutely shocked to find your kids got suckered into paying $29.95 for this thing.

And I'm not gonna criticize it anymore, because I can't. Somebody is getting rich off this stupid idea, and I'm on call trying to make a buck. They're obviously WAY ahead of me in laughing all the way to the bank.

Okay, all you armchair neurologists, I'm on call this weekend, and it's time for you to help me with DR. GRUMPY'S CHALLENGING PATIENT.

Here's the story:

Mrs. Smith was mugged outside Local Mall yesterday, in an event witnessed by several bystanders. Mr. Scumbag hit her over the head with a crowbar (she'll be fine, don't worry) knocking her out, and grabbing her purse (he's already been caught).

So she was admitted to Grumpy Hospital. And the admitting internist wrote in the chart:

I don't remember his name anymore. He'd had a massive stroke. Unable to speak. Came in completely comatose. He was in his late 70's.

He was there for a few days. Not a drop of sedation was given. He didn't wake up at all.

On day 2 of his stay, while the family was trying to make a decision, something went wrong with his foley (bladder) catheter. So the nurse had to change it. I was in the room looking at the chart when they started to pull it out.

He yelled, quite clearly, "SHIT!!! MY DICK!!!"

The nurse stopped. He was again completely comatose. I did every trick in the book to try and get him to speak again. Nothing worked. The nurse pulled out the foley, and put a new one in. No repeat performance.

He was there 3 more days before he died. He never said anything else. Every attempt by me and the nurses to try and find conciousness again failed.

To this day I have no idea how he did it. The MRI was awful looking. I can only assume it's some primordial part of the Y chromosome. No matter how badly damaged the upstairs is, you're still touchy about the downstairs.

"Hi, I have an appointment with Dr. Grumpy tomorrow at 11:15, and I need to know if that's 11:15 our time? Or is that 11:15 in another time zone? I really want to be there, so need to know if it's local time or not. Thank you."

Thank you for seeing my patient, Mrs. Complex. She's a very challenging case, and I'm glad you were willing to provide your expertise.

And you certainly didn't disappoint.

Your impression of her condition, with all of it's details, showed such remarkable deductive reasoning and was so brilliantly detailed, that I realize there was no way I'd ever have come to such a conclusion.

Yes, folks. That's the entirety of his impression and plan. The only thing I took out is the good doctor's name.

Quite a few readers have written in asking what I think of the Florida doctor who's told patients that voted for Obama to go find another doctor.

I'm sure it's legal. It's his practice. He can do what he wants.

But I don't think it's professional.

Part of being a doctor means treating people equally. Regardless of who they are. White or black, men or women, gay or straight, Republican or Democrat, Coke or Pepsi.

I don't discuss politics with patients. They ask me what I think of the new health care bill, and I give them a generic "We'll see what happens." Divisive discussions aren't good for a doctor-patient relationship.

Some people can be quite outspoken in their beliefs. I've taken care of a variety of ideologies. White supremacists. American neo-nazis. Socialists. Communists. Right, left, and in-between.

Sometimes it's hard to separate personal dislike from clinical judgment. But I do it, and try my best to treat all equally. And I never discuss my opinions with them.

"Dammit, Jim! I'm a Doctor!"

I am a person. With my own political beliefs. But there's no room for them in medicine. My job is to take care of people, and try to make them better, regardless of what I may think of them.

When President Reagan was shot, he famously quipped "I hope you guys are Republicans" to the surgical team as they were getting ready to operate on him, and the surgeon replied "We're all Republicans today."

Dr. Samuel Mudd went to jail for setting John Booth's broken leg after Booth shot President Lincoln.

The same trauma hospital in Dallas that frantically tried to save President Kennedy after he was shot, worked to save the life of his assassin, Lee Oswald, a few days later.

Caring for people equally, regardless of our personal thoughts about them, is what we do.

And if you don't think you can live up to that, then maybe you should find another profession.

Friday, April 2, 2010

Mrs. Old has numb feet. She lives in a nursing home. I've never seen her before.

Today her new nursing home doctor was rounding on her. He saw in her chart that she's had numb feet for over 10 years, but has never seen a neurologist for them. She also has Alzheimer's disease, so can't tell him much.

At 10:45 this morning Dr. Newbie called my office to see if I would see her. Because of transportation issues, they couldn't get her here until next Thursday. So he didn't make an appointment for her.

At 1:45 the hospital called me. Dr. Newbie actually admitted her for 10 years of foot numbness and 5 years of Alzheimer's disease, so she could see me before next Thursday.

I refused the consult. I am NOT going to be a party to such an insane waste of money.

Thursday, April 1, 2010

I am a faithful reader who checks in a couple times a day, and often I am shaking my head at the antics of your patients. Like others, I wonder sometimes if you write it up for the purposes of humor, because can people really be that idiotic?

This morning, I went to the doctors office early to have my fasting blood work drawn for an annual physical. My internist is in a large medical building with several practices on two floors. I overheard an older man say to the receptionist: "I have an appointment, but I'm not sure who it's with. I don't know the doctor's name or what it's for, but my appointment is at 8am this morning."

Dr. Grumpy, I now believe every word you write, verbatim.

Thank you for your great blog.

Amy

You're quite welcome, Amy. Thank you guys for reading it!

I refer you to the crazy patient scale, which I posted last Summer. To give credit, it was written by ER's Mom. And I thought it was just awesome.

Levels of Patient Crazy

1. Normal. They exist, even constitute the majority of patients. They make poor blog fodder, however, so you wouldn't know that that they even exist from reading any medical blog.

2. Crazy. These are the "fun crazy" folks. A little off, but you don't cringe when you see them on the schedule.

3. Bat-shit crazy. Your stomach drops a little when you see the name on the schedule.

4. Fucking Nuts. These folks seem intent on driving YOU nuts too.

5. Mouth agape and head shaking. You are lost for words upon meeting these folks. Fortunately, they are rare.

Two, maybe three pounds of grayish-white goop. It's not even solid in a living person. More like Jello that floats around in it's vault.

But it's amazing. From that sloppy goop has come remarkable stuff. It's sent a robot to land on a moon of Saturn. It's explored the bottom of our deepest oceans. Built the Taj Mahal. The Great Wall of China. Painted the Mona Lisa.

Go listen to the remarkable Bach's "Toccata and Fugue in D minor". Not just the famous opening 30 seconds or so, but the whole 9-10 minute thing. That all came from the goop, long before it was heard or played on an instrument, it was just a series of electric signals jumping from nerve to nerve. The piece is over 300 years old. The mind that created it has been dead for over 250 years. And humans will likely be listening to it long after my great-great-great-grandchildren are dust.

The soul is there. The heart is amazing, but for all our romantic beliefs about it, who we really are is floating around in the goop. It's where hate, love, and everything in between comes from.

It's capable of terrible evil, such as the Holocaust, and remarkable good. Look at the outpouring of altruism that follows disasters. I love my dogs, but if something bad happens to a dog on the next street, they're not going to care. Yet the goop wants to help people who we've never met and have no direct impact on our own lives

My regular readers know I'm interested in maritime history. Why? I have no idea. It's just been a subject I've loved as long as I can remember. I've never been in the navy. The family military history consists of grandparents who served in the army, but never were sent overseas. I can only assume there is some particular molecular structure in my goop that makes me interested in it. Or that made me want to treat other people's goop for a living.

Twin and biological studies have shown that most of who we are is how we came here. Yes, life experiences and background count for something, but the goop is most of it. People with conservative beliefs raise kids who turn out to be liberals, and vice versa, no matter how hard they may try to pass on their beliefs.

Coke vs. Pepsi. Dogs vs. Cats. Mac vs. Windows. I suspect whatever makes us fall on one side or the other of these great philosophical issues is 95% or more in the goop, and we just come that way.

Everything you are, have been, and will be. Have desired, dreamed of, and done. Have felt. It all comes from a few pounds of goop.

And this fascinates me. Because, let's face it, we're just another part of the planet. A collection of complex molecules, electrical impulses, and chemical reactions. That's all people. Anatomically, all humans are pretty much the same. And we're not that different from other mammals. The difference in our genetic sequence vs. that of a mouse ain't much.

And yet that small amount of difference has led to amazing results. The ability to think beyond our own biological needs and to see the world around us for the beauty it contains. To watch a sunset and be in awe, even though we understand the science behind it. And to look up at the night sky, and wonder.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

Singing Foo!

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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.